This document provides information about myocardial infarction (MI) or heart attack. It defines MI as reduced blood flow in a coronary artery due to atherosclerosis or blockage. MI is a leading cause of death. Risk factors include age, family history, smoking, hypertension, high cholesterol, diabetes and stress. Signs and symptoms include chest pain and shortness of breath. Diagnosis involves ECG, cardiac enzymes and angiography. Treatment includes aspirin, nitrates, beta blockers, statins, clot-busting drugs, angioplasty and bypass surgery. Complications can include arrhythmias, heart failure and heart rupture.
A cardiac dysrhythmia (also called an arrhythmia) is an abnormal rhythm of your heartbeat. It can be slower or faster than a normal heart rate. It can also be irregular. It can be life-threatening if the heart cannot pump enough oxygen-rich blood to the heart itself or the rest of the body.
A cardiac dysrhythmia (also called an arrhythmia) is an abnormal rhythm of your heartbeat. It can be slower or faster than a normal heart rate. It can also be irregular. It can be life-threatening if the heart cannot pump enough oxygen-rich blood to the heart itself or the rest of the body.
Cardiogenic shock : Medical Surgical NursingRaksha Yadav
This
presentation is designed for Nursing students and it gives a brief
about what you should know while caring for a client with Cardiogenic
shock and also its prevention.
Dumping syndrome is a set of a syndrome that can develop after gastric surgery due to rapid delivery of nutrients. Its symptoms can appear either within minutes of a meal or a few hours later. To get a detailed information on this, have a look at the attachment provided.
Myocardial infarction is the medical name of a heart attack. A heart attack is a life-threatening condition that occurs when blood flow to the heart muscle is abruptly cut off, causing tissue damage. This is usually the result of a blockage in one or more of the coronary arteries.Symptoms include tightness or pain in the chest, neck, back or arms, as well as fatigue, lightheadedness, abnormal heartbeat and anxiety. Women are more likely to have atypical symptoms than men.
Treatment ranges from lifestyle changes and cardiac rehabilitation to medication, stents, and bypass surgery.
This PPT contains all necessary detail about cholecystitis and its management and covers all aspects of this disease according to nursing point of view. Helpful for studetns.
Cardiogenic shock : Medical Surgical NursingRaksha Yadav
This
presentation is designed for Nursing students and it gives a brief
about what you should know while caring for a client with Cardiogenic
shock and also its prevention.
Dumping syndrome is a set of a syndrome that can develop after gastric surgery due to rapid delivery of nutrients. Its symptoms can appear either within minutes of a meal or a few hours later. To get a detailed information on this, have a look at the attachment provided.
Myocardial infarction is the medical name of a heart attack. A heart attack is a life-threatening condition that occurs when blood flow to the heart muscle is abruptly cut off, causing tissue damage. This is usually the result of a blockage in one or more of the coronary arteries.Symptoms include tightness or pain in the chest, neck, back or arms, as well as fatigue, lightheadedness, abnormal heartbeat and anxiety. Women are more likely to have atypical symptoms than men.
Treatment ranges from lifestyle changes and cardiac rehabilitation to medication, stents, and bypass surgery.
This PPT contains all necessary detail about cholecystitis and its management and covers all aspects of this disease according to nursing point of view. Helpful for studetns.
A myocardial infarction (commonly called a heart attack) is an extremely dangerous condition caused by a lack of blood flow to your heart muscle. The lack of blood flow can occur because of many different factors but is usually related to a blockage in one or more of your heart's arteries.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Objectives
Define and understand the epidemiology of MI’s and
how they are classified
Will be able to identify the risk factors associated with
MI’s
Will be able to recognize signs and symptoms of MI and
what the appropriate interventions are.
Understand the treatment options available to treat MI.
Nursing responsibilities
Follow up care
3. DEFINITION
. Myocardial infarction is a
disease condition which is
caused by reduced blood
flow in a coronary artery
due to atherosclerosis and
occlusion of an artery by
an embolus or thrombus
.
4. Epidemiology
MI’s are the leading cause of death in the United
States, affecting one in five men and one in six women.
450,000 people in the US die from coronary disease
each year.
5. MI Classifications
MI’s can be subcategorized by anatomy and clinical diagnostic
information.
Anatomic
Transmural - atherosclerosis involving a major coronary artery, it is usually as
a result of complete occlusion of the artery in addition on ECG ST elevation and
q waves are seen(STEMI)(epicardium,myo,endocardium)
Subendocardial - small area in the subendocardial wall of the left ventricle,
ventricular septum, or papillary muscles. It is particularly susceptible to
ischemia,in addition to ST depression is seen on ecg(NSTEMI)
Diagnostic
ST elevations (STEMI)-ECG must show new ST elevation in two or
more adjacent ECG leads or new LBBB , it must be greater than 2 mm in leads
V2 and V3 or greater than 1 mm in all other leads.
non ST elevations (NSTEMI)-ST segment depression ≥0.5mm or dynamic T-
wave inversion with pain or discomfort , and cardio specific proteinstroponin
are rises in blood in NSTEMI.
12. AGE: More than 40 years.
FAMILY HISTORY:
Myocardial infarction can
be inherited from parents
to children.
GENDER: Myocardial
infarction is 3 times more in
men than women.
14. HIGH BLOOD CHOLESTROL LEVEL
LOW DENSITY
LIPOPROTEIN
(LDL)
DANGEROUS
HIGH DENSITY
LIPOPROTEIN
(HDL)
LIPIDS
(LIPOPROTIENS)
15. HYPERTENSION
High blood pressure
our arteries are designed to pump blood at a certain
pressure. If that pressure is exceeded, the walls of the
arteries will be damaged
.
injury to endothelial lining , atherosclerosis
narrowed & thickened arterial walls
risk of M.I.
16. SMOKING
Smoking can damage the walls of your arteries.( toxic
substances in cigarette)
Atherosclerosis
narrowed & thickened arterial walls
Risk of M.I.
19. DIABETES MELLITUS
Diabetes increases the risk of MI because
it increases the rate of atherosclerotic
progression and adversely affects the lipid
profile
Risk of having M.I.
20. STRESS
Release stress hormones like adrenaline, noradrenaline, and
cortisol
increase in heart rate, and elevated blood pressure
it’s causing damage over time to all your blood vessel
That damage increases the risk of plaque buildup in coronary
arteries or can even cause a rupture of plaque
MI
The way you handle stress also matters. If you respond to it in
unhealthy ways -- such as smoking, overeating,or not exercising -
that makes matters worse.
23. Cholesterol deposition within the wall of the main artery
This deposited cholesterol ultimately forms a plaque in the wall of the artery called
atherosclerotic plaque. Atherosclerotic plaque formation is a long term process, required
many years to establish.
Sometimes this plaque may rupture or erode,it leads to activate clotting mechanism so
platelet aggregation and fibrin deposition, which lead to formation of an occlusive
thrombus in a coronary artery.
This occlusive thrombus completely block a coronary artery and interrupts blood supply to
part of the myocardium (heart muscle),
It lead to irreversible changes and death of myocardial cells, and ultimately ST-segment
elevation myocardial infarction develops.
PATHOPHYSIOLOGY
24. CLINICAL MANIFESTATIONS
Chest pain due to a lack of blood and
oxygen supply of the heart muscle
Characteristics: Severe, immobilizing
chest pain.
Usually prescribed as heaviness,
pressure, tightness, burning.
Location: Substernal, Retrosternal or
Epigastric.
Radiation: It may radiate to neck, jaw,
arm or back.
Duration: Lasts for 20 minutes or more.
PAIN
25. Cardiovascular-
Initially the BP and pulse may be elevated.
Later, BP will drop due to decreased cardiac
output.
palpitation.
Jugular veins may become distended and have obvious
pulsations.
26. CONTD…..
Respiratory-
Respiratory symptoms occur when the damaged the
heart muscle limits the pumping action of the left
ventricle, causing acute left heart failure and
consequent lung congestion.
Shortness of breath
Dyspnea/Tachypnea
Crackles
Pulmonary edema
27. Gastrointestinal-
Nausea
Vomiting
Stimulation of vomiting center by severe pain causes
nausea & vomiting
FEVER
It is due to inflammatory process caused by
Myocardial cell death.
28. In response to pain and the blood flow
abnormalities that result from
dysfunction of the heart muscle
SYMPATHETIC NERVOUS SYSTEM STIMULATION
Increased catecholamine releases.(adrenal medulla)
Diaphoresis (perfuse sweating
Cold & clammy skin (“cold sweat”).
Integumentary system (Skin)
cool, clammy skin
Diaphoresis
Pallor, Cyanosis
Coolness of extremities
29. Genitourinary-
Hypoperfusion to the kidneys leads to decrease renal
perfusion pressure which is required to maintain
glomerular filteration rate in the kidney
Decrease GFR leads to decrease urinary output
Urine output (Oliguria): 30ml/HR or <400ml/day.
Myocardial damage
Failure of the pump action of the heart,
resulting in reduced cardiac output
30. CONTD…..
Neurogenic-
due to inadequate blood flow to the brain
Light- headedness
Headache
Visual Disturbances
Altered speech
Altered motor functions
Altered level of consciousness
34. ASSESSMENT/DIAGNOSTIC FINDINGS
It is generally based on presenting symptoms, ECG and
laboratory test results.
Patient history-it includes
• Description of presenting
symptoms
• History of previous illness,
family health history
35. CONTD…..
Electrocardiogram-
ECG provides information that
assists in diagnosing acute MI.
The classic ECG changes are-
ST segment elevation
ST depression
T wave inversion
Abnormal Q wave
40. CK-MB- increases 3-6 hrs after onset of chest pain,
peaks in 12-18 hrs & return to normal within 3-4 days.
Cardiac troponin T- increases 4-6 hrs after MI &
persists for 2 weeks
Full blood count: WBC (white blood cell) count is usually
elevated. ESR (Erythrocyte sedimentation rate) and CRP
(C-reactive protein) may also elevate.
CHEST X-RAY
To detect cardiomegaly.
41. ECHOCARDIOGRAM
PURPOSE: it is useful to assess the ability of heart
muscles to contract & relax.
It is done to evaluate ventricular function by checking
ejection rate.
CT&MEGNATIC RESONANCE IMAGING (MRI)
PURPOSE: To detect site & extent of myocardial cells.
42. ANGIOGRAPHY
Angiography is used to detect
abnormalities,including narrowing
(stenosis) or blockages in the blood
vessels (called occlusions).
This is done by injecting a radio-
opaque contrast agent into the blood vessel this
dye makes the coronary arteries visible on x-ray
pictures. This helps doctors see blockages in the
arteries.
43. MANAGEMENT
GOALS
Restoration of the balance between the oxygen supply
and demand to prevent further ischemia
Pain relief
Prevention and treatment of any complications that
may arise
44. Chest pain suggestive of ischemia
Vital signs
12 lead ECG
Obtain initial
cardiac enzymes
electrolytes, cbc
lipids, bun/cr,
glucose, coags
CXR
Immediate assessment within 10 Minutes
Establish
diagnosis
Read ECG
Identify
complicatio-
ns
Assess for
reperfusion
Initial labs
and tests
Emergent
care
History &
Physical
Cardiac monitoring
IV access
Morphine
Oxygen<94%
Nitrates
Aspirin
48. ANTIPLATELET DRUG (Decrease platelet aggregation and
inhibit thrombus formation)
Aspirin(160 to 325mg) slows the blood's clotting action
by reducing the clumping of platelets
Clopidogrel(300mg) -works by blocking platelets from
sticking together and prevents them from forming
harmful clots. It is an antiplatelet drug.
DRUG THERAPY
49. ANALGESIC:
NITRATES.
Sublingual Nitroglycerine- Nitrates act as a vasodilator
and relief pain,Total 3 doses (can repeat 3-5mts if no
contraindication)-use only SBP ˃ 90mmhg heart rate 50-100/mt
Morphine Sulphate.
produces central nervous system analgesia.
Produce venodilation(it helps to reduce left ventricular
preload and oxygen demand)
50. BETAADRENERGIC BLOCKERS
(Propanolol) it inhibit SNS stimulation of heart.
reduces both heart rate & contractility
CALCIUM CHANNEL BLOCKERS
(Verapamil, Nifedipine)
It causes coronary artery vasodilatation & decreases
myocardial contractility.
Increases blood supply to myocardium & decreases
O2 demand of myocardium.
ANTI COAGULATION THERAPY (prevent the formation
of blood clots)
LMWH-ENOXAPARIN
UNFRACTIONED HEPARIN
51. ACE Inhibitors
These medicines lower bloodpressure
and reduce the strain on your heart.
They also help slow down further
weakening of the heart muscle.
Eg:enalapril, captopril
52. FIBRINOLYTIC THERAPY
TIME OF ADMINISTRATION:
Thrombolytics are given to the
patient upto 12 hours of onset of
chest pain but for best results it
should be given within 1 hr after
onset of chest pain.
ACTION: These will dissolve &
do lysis of thrombus in coronary
artery.
We are using metalyse for
thrombloysis
If STEMI is present, the goal is
to achieve a door- to –drug
time of 30 min & a door-to –
balloon time of within 90 min.
Indicated for patients with STEMI MI’s.
53. Absolute & relative contraindications
for thrombolytic therapy
Absolute contraindications-
Any prior ICH
Ischemic stroke within 3 months
Known structural cerebral vascular lesion
Known malignant intracranial neoplasm
Active bleeding
Significant closed head trauma within past 3
months
54. Relative contraindications-
History of chronic, severe, poorly controlled
hypertension
Severe uncontrolled hypertension on presentation
History of prior ischemic stroke >3months
Dementia
Pregnancy
Active peptic ulcer
Current use of anticoagulants, the higher the INR the
greater the risk
55. Angioplasty
During angioplasty, a thin, flexible tube with a balloon
on the end is threaded through a blood vessel to the
blocked coronary artery. Then,the balloon is inflated
to push the plaque against the wall of the artery.This
widens the inside of the artery,restoring blood flow.
Also a small mesh tube called a stent may be put in the
artery to help keep it open.Some stents are coated with
medicines that help prevent the artery from becoming
blocked again.
SURGICAL MANAGEMENT
59. CORONARY ARTERY BYPASS GRAFT (CABG)
A form of bypass surgery that
can create new routes around
narrowed and blocked
coronary arteries, permitting
increased blood flow to deliver
oxygen and nutrients to the
heart muscle.
Coronary artery bypass graft is
an option for selected groups
of patients with significant
narrowings and blockages of
the heart arteries.
The bypass graft for a CABG
can be a vein from the leg or
an inner chest-wall artery.
60. COMPLICATIONS
Dysrrythmias -Damaged heart muscle disrupts electrical
signals and produces arrhythmia in which heartbeat may be too
fast, too slow or irregular like VF,VT,AF
Cardiogenic shock- It may develop after the large territory
heart muscle damage. It leads to failure of the pumping action of
the heart. The end results are very low blood pressure with an
inadequate supply of oxygen rich blood to vital organs most
significantly the brain, kidneys and heart
Heart failure- It occurs slowly over time after an attack in
which the heart cannot pump enough blood to meet the body’s
demand
Embolism. sometimes thrombus may dislodged from
heart and may cause stroke (if reach in the brain) or
ischemic limb (if reach in the limb)
61. mechanical complications
It is due to tear or rupture of infarcted heart muscle. It
includes-
Severe mitral regurgitation – it is due to rupture of
papillary muscle(leakage of blood backward through
the mitral valve from left ventricle to lt atrium )
Cardiac tamponade – it is due to rupture of ventricle.
Right heart failure – it is due to rupture of
interventricular septum.
Late complications:
These develop after one week of attack and include:
Dressler’s syndrome-
This syndrome is characterized by fever, pleuritis and percarditis.
It is caused by an autoimmune reaction to damage heart muscle
62. Nursing diagnosis
Acute pain R/T myocardial ischemia resulting from
coronary artery occlusion
Outcome- the client will experience improved comfort as
evidenced by dec. in pain rating scale.
Interventions- assess characteristics of pain
Assess respiration, BP, heart rate with each episode of chest
pain.
Obtain 12 lead ECG on admission & on each episode of
chest pain.
Monitor respond to drug therapy.
Limit visitors.
As morphine as ordered.
Administer nitrates as ordered.
63. Ineffective tissue perfusion R/T thrombus in coronary
artery
Outcome- the client will demonstrate improved
cardiac tissue perfusion as evidenced by dec. rating of
pain.
Interventions- provide bed rest.
Administer oxygen as prescribed.
Administer thrombolytics.
Monitor ST segments.
64. Dysrrhythmias R/T electrical instability or irritability
secondary to infarcted tissue
Outcome- the client will have no dysrrythmias as
evidenced by normal sinus rhythm.
Interventions- teach client & family about need for
continous monitoring.
Assess apical heart rate.
Give antidysrrythmic agents as ordered.
Monitor effects of antidysrrythmics.
Monitor serum K levels.
Maintain patent IV line.
Monitor ST segments & document changes.
65. Risk for bleeding R/T coagulopathies with
thrombolytic therapy.
Powerlessness R/T a near-death experience &
anticipated lifestyle changes.
Anxiety & fear R/T hospital admission & fear of death.
Risk for constipation R/T bed rest, pain medications &
NPO or soft diet.
Ineffective health maintenance R/T MI & implications
for lifestyle changes.
Risk for activity intolerance R/T an imbalance b/w
oxygen supply & demand.
66. Health education
Proper medication compliance (right dose and right
time)
Perform exercise
Do not smoke
follow the diet plan
Maintain a healthy weight
Manage your stress
signs and symptoms to be reported to physician
67. Conclusion :
MI is a life threatening disease caused by many factors.
Health education must be given to the patients with
predisposing or risk factors to prevent it. Early
diagnosis is also very important for saving the life of
the patient.
68. REFERENCE
Mosby’s Comprehensive Review of Nursing
Dolores F.Saxton,Patricia M.Nugent.
The Lippincott Manual of Nursing Practice
https://en.wikipedia.org/wiki/Myocardial_infarction